Risk Adjustment Coding Auditor, Sr

Risk Adjustment Coding Auditor, Sr page is loaded## Risk Adjustment Coding Auditor, Srremote type:
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Posted 2 Days Agojob requisition :
JR100739

Risk Adjustment Coding Auditor, Sr---------------------------------------------------------------The Coding Auditor, Senior performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines.

Specific approaches to job duties vary depending on the department.
** Estimated Hiring Range:**$81,000.00 - $99,000.00
** Bonus Target:
** Bonus - SIP Target, 5% Annual Current Care Oregon Employees:
Please use the internal Workday site to submit an application for this job.

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** Essential Responsibilities
*** Perform and lead a variety of coding-related audits for providers and other entities.
* Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data.
* Communicate audit results and recommendations for improvement to providers when needed.
* Create and maintain processes for tracking audit results and outcomes of reviews.
* Identify, track, analyze and report on any trends revealed in audits.
* Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders.
* Lead the development of educational materials and process documentation in a variety of mediums (e.g., recorded training sessions, reference documentation, etc.).
* Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations by frequently referencing current ICD-10-CM and CMS manuals, reviewing professional publications, and attending educational workshops/conferences.
* Maintain active coding certification.
* Seek out emerging coding best practices using a variety of strategies (e.g., establishing personal networks, participating in professional associations, etc.).
* Serve as subject matter expert regarding correct coding practices.
* Work with Risk Adjustment team to create Standard Operating Procedures (SOPs), process flows and contribute to roadmaps for future state Risk Adjustment Coding initiatives.
* Onboard and train new Coding Auditors.
* Oversee and audit Coding Auditor coding results; providing feedback and retraining, as needed.

Applies to Finance (Risk Adjustment) Department
* Lead Risk Adjustment Data Validation RADV and other diagnosis code related audits (applies to Finance department roles only).
* Perform and lead a variety of coding-related audits for providers and other entities including activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including Medicare Advantage Risk.
* Adjustment and CDPS+RX in accordance with all state regulations, federal regulations, internal policies, and internal procedures.
* Perform Retrospective and Concurrent chart reviews to ensure accurate risk adjustment reporting.
* Verify and ensure the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation. This includes applicable vendor reported diagnosis codes.
* Review medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
* Serve as a risk adjustment coding resource and subject matter expert, offering guidance and clarification on coding and compliance questions.###
** Experience and/or Education
** Required* Minimum 5 years’ experience as certified coder
* Current coding certification from AHIMA or AAPC
* One-year experience with risk adjustment program in a Health Plan (applies to roles in Finance/Risk Adjustment…